<p> Directions for completing this form found on back side. Must be filled in completely in blue or black ink or typed (no pencil).</p><p>Member’s Name ______</p><p>Phone______Age on January 1 ______</p><p>Mailing Address______City______</p><p>State ______Zip Code______County ______</p><p>Email Address ______</p><p>Club______</p><p>Do you need any physical and/or educational accommodations in order to participate fully in 4-H Animal Science activities and events?</p><p> No</p><p> Yes</p><p>List accommodation needed: (for instance, help reading a quiz, modified equipment, etc.) ______</p><p>Owned or Sex or spayed/ Leased? Please list (microchip or Fit & Show Class Obedience Class Animal Name tattoo) if dog has one. neutered Include date of ownership/lease</p><p>This certifies that the above exhibitor is a 4-H member in good standing and the animals listed above the 4-H county staff signature are eligible to be shown by this member. 4-H county staff will use date received in office. Registration papers should be available upon request. Animals to be shown in any 4-H classes must be listed and submitted to your 4-H County Extension office on or before the deadlines listed on the back of this form. This form does NOT constitute a fair entry. Separate entries must be made to shows at fairs. This form with 4-H county staff signature must be presented to the Superintendent of each 4-H Show in which you participate and must agree with information on registration papers. 4-H members are responsible for the accuracy of all information provided. The 4-H county staff signature is verification of date of submission only. No changes or additions are to be made to this 4-H Animal Intent to Show form without a 4-H county staff initialing the change. Rabies requirement - All animals exhibited at a 4-H show or event must be vaccinated for rabies. REMINDER: All animals must have been vaccinated for rabies 30 days prior to first event or show.</p><p>Leader Signature Parent Signature Member Signature Date The 4-H office must have an electronic copy (4-H Online) or a paper copy of your Youth Medical Care and Treatment form and the Youth Code of Conduct/Permission Release form. Revised 2.2016 MEMBER INSTRUCTIONS FOR COMPLETING 4-H Dog Intent to Show Form</p><p>On your Intent to Show Form, list all 4-H project dogs to be shown. (Hint: It is best to include all eligible project dogs; your favorite might not be feeling well on show day.) Print In Blue or Black Pen or Type. Complete the form including your mailing address with zip code, email, and age as of 1/1 of the current year. List one dog per line. Do not skip any lines. Print clearly. Remember, All Dogs In A 4-H Project Must Be Solely Owned Or Leased By The 4-H Member. (The Kennel name cannot be used for owner of animals). Deadline for submitting Dog Intent to Show Form to your 4-H County Extension office for signature is May 1st: All 4-H project dogs must be at least four months by show day to be shown, exhibited or brought to any given 4-H event. For instance, a dog born on April 30, 2015 could not be exhibited or brought to a 4-H event before August 30, 2015.</p><p>1. Breed: List the breed of your dog. (or crossbreed) 2. Dog name: List the dog’s name. 3. If your dog has a microchip or a tattoo, please list it. All dogs shown and exhibited should have a permanent form of identification. 4. Date of Birth: Enter the dog’s date of birth. 5. Sex: Enter the sex of your dog and whether he/she has been spade/neutered. 6. Owned or Leased - Indicate Owned (O) or Leased (L) in this space. Registration papers or record of lease MUST be in the exhibitor’s name. If leasing, please refer to fact sheet “Suggestions for setting up 4-H leases”. Include the date the 4-H member owned or leased the animal. 7. Show Class: List proposed show class, your proposed fit and show and your proposed obedience level for your dog. For more information review the NH Guide to 4-H Dog Shows online at http://extension.unh.edu/4-H-Animal- and-Ag-Science/4-H-Dog-Page. 8. Submit this form to your 4-H Extension office prior to the proper date (May 1st). The 4-H county staff will sign, date, and validate your form prior to returning it to you. 9. Forms not filled out properly will be returned. It is the member’s responsibility to correct the form and return it to the 4-H office by the deadline. 10. Replacement dogs are not allowed after Intent to Show Form deadline. In the case of dog’s death - please see your 4-H county staff and refer to NH 4-H Policy on Replacement Animals.</p><p>UNH Cooperative Extension is an equal opportunity educator and employer, University of New Hampshire, U.S. Dept. of Agriculture and NH counties cooperating.</p><p>Page 2 of 2 Revised 2.2016</p>